Inspection on 28/04/05 for Humphry Repton House

This inspection was carried out on 28th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Humphry Repton House 17/12/08

Humphry Repton House 22/11/07

Humphry Repton House 06/10/06

Humphry Repton House 01/11/05

Humphry Repton House 19/10/04

Humphry Repton House 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Humphrey Repton House Brentry Lane Bristol BS10 6NA Lead Inspector Vanessa Carter Unannounced 28 April 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Humphrey Repton House Version 1.10 Page 3 SERVICE INFORMATION Name of service Humphrey Repton House Address Brentry Bristol BS10 6NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 959 2255 0117 970 9301 Aspects & Milestones Trust Mrs Deborah Jane Stone Care home with nursing 30 Category(ies) of DE Dementia (5) registration, with number DE (E) Dementia over 65 (30) of places Humphrey Repton House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. Manager must be a RN on Parts 3 or 13 of the NMC regsiter. 2. Staffing notice 22/03/2000. Date Implemented: 1 April 2002 3. May accommodate up to 6 additional persons for day care only. 4. May accommodate up to 5 persons aged 50 years and over with dementia. 5. May accommodate up to 30 persons aged 65 and over with dementia. Date Implemented: 4 June 2004 Date of last inspection 19/10/2004 Brief Description of the Service: Humphrey Repton House is a 30 bedded care home operated by Aspects and Milestones. Aspects and Milestones are a Bristol based, non-profit making charity, with several other care homes and small group homes, in the city. The home is registered to provide both personal and nursing care for up to 30 persons who have dementia. In addition the home is registered to take up to five people between the age of 50-65 with a dementia. The home currently takes up to five people each day, for daycare services, in the same category. Humphrey Repton House is set in large grounds and is a purpose built home. It comprises of three “wings” which, along with the service area of the house, are arranged in a cruciform style. Each wing has its own separate lounge and dining area as well as bathing facilities. The three wings are single storey and only the service area has a second floor, housing offices and the staff areas. Central to the home is an enclosed courtyard, with raised flower beds. Building is already underway to extend the facilities at Humphrey Repton House. Although the home will retain its name it will also be known as the Bristol Dementia Centre. The home will then be able to offer a further 12 bedrooms, two self-contained respite care beds and a separate day care facility Humphrey Repton House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day. Evidence was gathered from • Talking to staff • Talking with visitors • observation • records • looking at the premises • discussing plans to improve and extend the service. What the service does well: What has improved since the last inspection? What they could do better: A requirement has been made to make all bathrooms fit for use, so that residents have more choice. The home must make sure that residents or their representatives are given a statement about what weekly charges are made and who is responsible for them. The home needs some redecoration and refurbishment so that the environment is more attractive. Residents would benefit from a less crowded feeling in the main reception area. This is being addressed by the planned building and refurbishment/ Humphrey Repton House Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Humphrey Repton House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Humphrey Repton House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, and 4 The home has a robust admissions process, ensuring that the staff team can meet the specific needs of any prospective new resident EVIDENCE: The home does not issue a statement of terms and conditions to all residents at the time of moving into the home, instead doing this after a one month trial. The statement must include details of fee’s payable and by whom (service user, local or health authority, relative or another). A requirement was made following the last inspection, but has not been fully complied with. The homes pre-admission assessment tool is comprehensive and detailed and ensures that new residents are properly assessed and planned for. The assessment for the most recently admitted resident, contained significant information in relation to their specific needs, and this isthen followed through into the care planning documentation. The home is registered to provide placement for people with dementia, who may also have challenging behaviour, and the staff demonstrate that they have the specialist skills to care for the residents. Humphrey Repton House Version 1.10 Page 9 As part of the new building works, two self contained respite rooms will be provided within the home and this will provide a valuable community resource. Humphrey Repton House Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,9 and 10 The home ensures that the health, personal and social care needs of each person are identified and met. The staff have a good understanding of the residents support needs and positive interaction is evident with family visitors. Medication is well managed. EVIDENCE: Each resident has an individual, “person centred”, plan of care that details out his or her specific needs. They are written in the form of “Things I need help with” and cover all aspects of health, personal and social care needs. The plans are written in collaboration with resident’s family or representatives, and signed as agreed. There was evidence that the plans are reviewed and updated on a monthly basis, and a complete re-assessment undertaken every six months. This is good practice. At each change of shift the staff team receive a full handover. Any changes in a persons condition are discussed. In addition a daily record is kept of care given and other significant events. A sample of three plans evidenced that other healthcare professionals such as the GP, free nursing care team, opticians, dentists and chiropody see residents. The majority of residents are registered with one GP who has a particular interest in the care of people with dementia. Humphrey Repton House Version 1.10 Page 11 Risk assessments had been completed and updated when necessary. Discussions with staff regarding the care needs of one resident who was at high risk of falls, evidenced that they had planned, in order to minimize the risk of falls and injury. This person was receiving an increased level of support, and protective equipment was being trialled, whilst other agencies were determining the best approach in dealing with the situation. Personal care was observed being given with respect to the dignity and privacy of the residents. Since the last inspection the bedroom doors have been fitted with locks so that the doors can be secured, preventing a wandering person from entering into the room. The medication systems in the home are well managed and the staff follow established routines for the safe receipt, storage, administration and disposal of medicines. Humphrey Repton House Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 The residents have a varied and stimulating environment, with visitors being able to visit the home as and when they are able. The residents are assisted by the staff to exercise choice, in how they spend their time. EVIDENCE: There are daily activities for individuals or groups or residents and for people who come for day care. There is a range of activities and some are provided by outside entertainers. Activities include music sessions, pets as therapy, exercise groups and films. One resident was dancing with a carer and another was taking exercise. A care assistant was helping someone to settle using hand massage and aromatherapy. Residents have daily care plans and can get up or go to bed when they wish. Care plans are amended daily where necessary. A previously very active resident, was helped to move around despite their physical difficulties. A relative said that the home always involves the family in the care of their relative. The main meal looked appetising and was served according to the individual eating needs of residents. This evidenced that residents are cared for as individuals and is good practice. Humphrey Repton House Version 1.10 Page 13 Five people come to the home for day care every day. As they are cared for in the main reception area, the home appears crowded. This will improve when the building works are complete. Humphrey Repton House Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure is available to service users and their representatives and there is evidence that concerns are listened to and acted upon. EVIDENCE: The home has a satisfactory complaints system, but due to the nature of the resident’s individual mental health problems, it is not possible to determine whether they feel that any complaints they have are addressed. Evidence was obtained from visitors to the home, that they are familiar with the homes complaints procedure and feel confident that any complaints they may need to make, would be taken seriously. The appropriate information and contact telephone numbers are displayed in the main lobby. The home have had only one complaint in the last 12 month and the home are still in the process of investigating the concerns that have been raised. The nature of the complaint was discussed during the inspection. The manager explained that the staff team have annual adult abuse training and this was confirmed in discussion with both qualified and unqualified staff. In addition the home has a policy on restraint. The home keeps appropriate records when the staff need to use physical intervention, and the notes for one person were examined. Humphrey Repton House Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20,and 21 The standard of décor within the home is poor however there are plans to address this. This will enhance the environment for the residents. The home does not have sufficient suitable bathing facilities EVIDENCE: The home is currently undergoing major building works, although these are currently external to the living environment. A further 12 bedrooms will be provided with new laundry and kitchen provision, and a day care unit. The existing kitchen and laundry facilities will be altered into two self-contained short term placement rooms. It is expected that the completion date will be early 2006. The present facilities are fit for the purpose of a care home and have been designed to meet the needs of dementia care residents who may wander. The home is built around a central courtyard, with communal areas on each of the four sides – these are linked enabling the residents to wander from one area to another in safety. Humphrey Repton House Version 1.10 Page 16 Three of the wings each have ten single bedrooms. Since the last inspection, door locks have been fitted to the bedroom doors so that privacy can be maintained whilst personal care is being provided. The decoration of the home is presently worn and tired looking. Future plans for the home involves the upgrading and refurbishment of the existing facilities, in order that the old and new environments are the same. Some of the carpets in the home are in need of replacement, as detailed in the last report, however this will be addressed as part of the refurbishment programme. All bedrooms have wash hand basins. The three wings each have level access shower rooms, and a toilet, plus there is an additional specialist bathroom. This room has been out of use for a while, and on the day of inspection one of the shower rooms was also temporarily out of order. Humphrey Repton House Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staff team has now stabilised ensuring that consistency of care is provided, by well qualified staff. EVIDENCE: Since the last inspection, the home has established a stable staff team and the use of agency staff has reduced. Staff reported that this has resulted in an improvement in the morale of the team. One qualified nurse staffs each of the wings along with two carers each shift. A study of the duty rota confirmed this. In addition there are ancillary staff including housekeepers, kitchen staff and day care assistants, and a full time Home Manager. The qualified nurses are each assigned to one of the wings, however ensure that they keep an overview of all the residents in the home. There is a programme of National Vocational Qualification training for the care staff and in-house assessors will enable the home to achieve the target. Approximately one third of staff are currently NVQ Level 2 trained, with further staff working towards achievement. Humphrey Repton House Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31and 38 The home is well managed, with a committed staff team who work well together. Residents benefit from a safe and secure environment, that is well maintained. EVIDENCE: The home manager has been in post since November 2003, is a registered nurse in mental health, and is planning to undertake a management qualification. She is supported by a deputy manager, a team of qualified nurses, and experienced care assistants. It is evident that the team have strong leadership and work well together in order to provide a good quality service for the residents. Visitors to the home made positive comments in respect of the staff team, and their approach with both the residents and themselves. Records evidenced that all necessary fire checks and drills are undertaken on a regular basis, and maintenance contracts are all in place. Humphrey Repton House Version 1.10 Page 19 Risk assessments are carried out for all safe working practices and records are maintained when any restrictive measures need to be taken to secure a residents safety. Humphrey Repton House Version 1.10 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 1 x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Humphrey Repton House Version 1.10 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5a Requirement Timescale for action From receipt of report 2. OP21 23(2)j The home must issue a statement of terms and conditions to all residents or their representatives, upon admission to the home. The statement must contain details regarding weekly charges, and who may be responsible for parts of these. The home must provide bathing 01.09.05 facilities in such numbers that meet the needs of the residents. This has been determined to be at the ratio of 1:8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Humphrey Repton House Version 1.10 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Humphrey Repton House Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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